Complaint Investigation Report

306002853-5-27-2026-22-AS-KSGH-DUMTA6-20260601143302

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

ORANGE COUNTY RO , 770 THE CITY DR., SUITE 7100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

05/13/2026 and conducted by Evaluator Ruth Martinez

COMPLAINT CONTROL NUMBER: 22-AS-20260513084703

Staff is not allowing resident to be readmitted to facility

Staff did not ensure reporting requirements were followed

Staff did not ensure a needs assessment evaluation was conducted for resident in care

Licensing Program Analysts (LPAs) Ruth Martinez and Nancy Guillen conducted an unannounced visit to the facility to investigation the above identified complaint allegations and delivered findings. LPAs arrived at facility and were greeted at the door and granted entry by caregiver. LPAs spoke with Carmen Achim, Administrator, and explained the purpose of the visit.

After further investigation into this complaint and information received LPAs determined that this complaint was written under the wrong facility license number. LPA’s investigation determined that resident (R1) has never resided at this facility. We have found the complaint allegations are unfounded, meaning that the allegations are false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator and a copy of this LIC9099 report was left at facility.